Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Ahead of Print
    • Past Issues
    • Supplements
    • Article Type
  • Specialty
  • CME/MOC
    • Articles
    • Calendar
  • COVID-19
    • Curbside Consults Overview
    • Pulmonary/ICU
    • Patient Subsets & Specific Organ Involvement
    • Therapies and Vaccines
    • Imaging & Procedures
    • Patients with Underlying Disease
    • Virus Background & Testing
    • Healthcare System Practice
  • Info For
    • Manuscript Submission
      • 1-Minute Consult
      • Commentary
      • Current Drug Therapy
      • Editorial
      • Guidelines to Practice
      • Interpreting Key Trials
      • Letter to the Editor
      • Review
      • Smart Testing
      • Symptoms to Diagnosis
      • The Clinical Picture
    • Authors & Reviewers
    • Subscriptions
    • About CCJM
    • Contact Us
  • Conference Coverage
    • ASH Annual Meeting
    • AHA Sessions 2020
    • IDWeek 2020
    • CHEST 2020
    • ADA 2020
    • ACC 2020
  • Advertise
    • Media Kit
    • Contact
  • Other Publications
    • www.clevelandclinic.org

User menu

  • Register
  • Log in

Search

  • Advanced search
Cleveland Clinic Journal of Medicine
  • Other Publications
    • www.clevelandclinic.org
  • Register
  • Log in
Cleveland Clinic Journal of Medicine

Advanced Search

  • Home
  • Content
    • Current Issue
    • Ahead of Print
    • Past Issues
    • Supplements
    • Article Type
  • Specialty
  • CME/MOC
    • Articles
    • Calendar
  • COVID-19
    • Curbside Consults Overview
    • Pulmonary/ICU
    • Patient Subsets & Specific Organ Involvement
    • Therapies and Vaccines
    • Imaging & Procedures
    • Patients with Underlying Disease
    • Virus Background & Testing
    • Healthcare System Practice
  • Info For
    • Manuscript Submission
    • Authors & Reviewers
    • Subscriptions
    • About CCJM
    • Contact Us
  • Conference Coverage
    • ASH Annual Meeting
    • AHA Sessions 2020
    • IDWeek 2020
    • CHEST 2020
    • ADA 2020
    • ACC 2020
  • Advertise
    • Media Kit
    • Contact
Current Drug Therapy

Hydroxychloroquine: An old drug with new relevance

Eugen Alexander Shippey, MD, Vanya D. Wagler, DO, FACP, FACR and Angelique N. Collamer, MD, FACP, FACR
Cleveland Clinic Journal of Medicine June 2018, 85 (6) 459-467; DOI: https://doi.org/10.3949/ccjm.85a.17034
Eugen Alexander Shippey III
Resident, Department of Internal Medicine, William Beaumont Army Medical Center, El Paso, TX
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: eugen.shippey@gmail.com
Vanya D. Wagler
Department of Rheumatology, William Beaumont Army Medical Center, El Paso, TX
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Angelique N. Collamer
Chief, Department of Rheumatology, Walter Reed National Military Medical Center, Bethesda, MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

REFERENCES

  1. ↵
    1. Sanofi-Aventis
    . Product monograph: Plaquenil. http://products.sanofi.ca/en/plaquenil.pdf. Accessed May 2, 2018.
  2. ↵
    1. Centers for Disease Control and Prevention (CDC)
    . Malaria information and prophylaxis, by country. www.cdc.gov/malaria/travelers/country_table/a.html. Accessed May 2, 2018.
  3. ↵
    1. Wallace DJ
    . The history of antimalarials. Lupus 1996; 5(suppl 1):S2–S3. pmid:8803902
    OpenUrlCrossRefPubMed
  4. ↵
    1. Shee JC
    . Lupus erythematosus treated with chloroquine. Lancet 1953; 265(6778):201–202. pmid:13070595
    OpenUrlPubMed
  5. ↵
    1. Kuznik A,
    2. Bencina M,
    3. Svajger U,
    4. Jeras M,
    5. Rozman B,
    6. Jerala R
    . Mechanism of endosomal TLR inhibition by antimalarial drugs and imidazoquinolines. J Immunol 2011; 186:4794–4804. doi:10.4049/jimmunol.1000702
    OpenUrlAbstract/FREE Full Text
  6. ↵
    1. Willis R,
    2. Seif AM,
    3. McGwin G Jr.,
    4. et al
    . Effect of hydroxychloroquine treatment on pro-inflammatory cytokines and disease activity in SLE patients: data from LUMINA, a multiethnic US cohort. Lupus 2012; 21(8):830–835. doi:10.1177/0961203312437270
    OpenUrlCrossRefPubMed
  7. ↵
    1. Fox R
    . Anti-malarial drugs: possible mechanisms of action in autoimmune disease and prospects for drug development. Lupus 1996; 5(suppl 1):S4–S10. pmid:8803903
    OpenUrlCrossRefPubMed
  8. ↵
    1. Ruiz-Irastorza G,
    2. Ramos-Casals M,
    3. Brito-Zeron P,
    4. Khamashta MA
    . Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: a systematic review. Ann Rheum Dis 2010; 69(1):20–28. doi:10.1136/ard.2008.101766
    OpenUrlAbstract/FREE Full Text
  9. ↵
    1. Lam NC,
    2. Ghetu MV,
    3. Bieniek ML
    . Systemic lupus erythematosus: primary care approach to diagnosis and management. Am Fam Physician 2016; 94(4):284–294. pmid:27548593
    OpenUrlPubMed
  10. ↵
    1. Jung H,
    2. Bobba R,
    3. Su J,
    4. et al
    . The protective effect of antimalarial drugs on thrombovascular events in systemic lupus erythematosus. Arthritis Rheum 2010; 62(3):863–868. doi:10.1002/art.27289
    OpenUrlCrossRefPubMed
  11. ↵
    1. Nuri E,
    2. Taraborelli M,
    3. Andreoli L,
    4. et al
    . Long-term use of hydroxychloroquine reduces antiphospholipid antibodies levels in patients with primary antiphospholipid syndrome. Immunol Res 2017; 65(1):17–24. doi:10.1007/s12026-016-8812-z
    OpenUrlCrossRef
  12. ↵
    1. Erkan D,
    2. Aguiar CL,
    3. Andrade D,
    4. et al
    . 14th International Congress on Antiphospholipid Antibodies: task force report on antiphospholipid syndrome treatment trends. Autoimmun Rev 2014; 13(6):685–696. doi:10.1016/j.autrev.2014.01.053
    OpenUrlCrossRefPubMed
  13. ↵
    1. Jalal H,
    2. O’Dell JR,
    3. Bridges SL Jr.,
    4. et al
    . Cost-effectiveness of triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis. Arthritis Care Res (Hoboken) 2016; 68(12):1751–1757. doi:10.1002/acr.22895
    OpenUrlCrossRef
  14. ↵
    1. Avina-Zubieta JA,
    2. Galindo-Rodriguez G,
    3. Newman S,
    4. Suarez-Almazor ME,
    5. Russell AS
    . Long-term effectiveness of antimalarial drugs in rheumatic diseases. Ann Rheum Dis 1998; 57(10):582–587. pmid:9893568
    OpenUrlAbstract/FREE Full Text
  15. ↵
    1. Gottenberg JE,
    2. Ravaud P,
    3. Puechal X,
    4. et al
    . Effects of hydroxychloroquine on symptomatic improvement in primary Sjogren syndrome. JAMA 2014; 312(3):249–258. doi:10.1001/jama.2014.7682
    OpenUrlCrossRefPubMed
  16. ↵
    1. Petri M
    . Hydroxychloroquine use in the Baltimore Lupus Cohort: effects on lipids, glucose and thrombosis. Lupus 1996; 5(suppl 1):S16–S22. pmid:8803905
    OpenUrlCrossRefPubMed
  17. ↵
    1. Cairoli E,
    2. Rebella M,
    3. Danese N,
    4. Garra V,
    5. Borba EF
    . Hydroxychloroquine reduces low-density lipoprotein cholesterol levels in systemic lupus erythematosus: a longitudinal evaluation of the lipid-lowering effect. Lupus 2012; 21(11):1178–1182. doi:10.1177/0961203312450084
    OpenUrlCrossRefPubMed
  18. ↵
    1. Charles-Schoeman C,
    2. Wang X,
    3. Lee YY,
    4. et al
    . Association of triple therapy with improvement in cholesterol profiles over two-year followup in the treatment of early aggressive rheumatoid arthritis trial. Arthritis Rheumatol 2016; 68(3):577–586. doi:10.1002/art.39502
    OpenUrlCrossRefPubMed
  19. ↵
    1. Penn SK,
    2. Kao AH,
    3. Schott LL,
    4. et al
    . Hydroxychloroquine and glycemia in women with rheumatoid arthritis and systemic lupus erythematosus. J Rheumatol 2010; 37(6):1136–1142. doi:10.3899/jrheum.090994
    OpenUrlAbstract/FREE Full Text
  20. ↵
    1. Wasko MC,
    2. Hubert HB,
    3. Lingala VB,
    4. et al
    . Hydroxychloroquine and risk of diabetes in patients with rheumatoid arthritis. JAMA 2007; 298(2):187–193. doi:10.1001/jama.298.2.187
    OpenUrlCrossRefPubMed
  21. ↵
    1. Sun L,
    2. Liu M,
    3. Li R,
    4. et al
    . Hydroxychloroquine, a promising choice for coronary artery disease? Med Hypotheses 2016; 93:5–7. doi:10.1016/j.mehy.2016.04.045
    OpenUrlCrossRef
  22. ↵
    1. Tett SE,
    2. Cutler DJ,
    3. Day RO,
    4. Brown KF
    . Bioavailability of hydroxychloroquine tablets in healthy volunteers. Br J Clin Pharmacol 1989; 27(6):771–779. pmid:2757893
    OpenUrlCrossRefPubMed
  23. ↵
    1. Furst DE
    . Pharmacokinetics of hydroxychloroquine and chloroquine during treatment of rheumatic diseases. Lupus 1996; 5(suppl 1):S11–S15. pmid:8803904
    OpenUrlCrossRefPubMed
  24. ↵
    1. Frances C,
    2. Cosnes A,
    3. Duhaut P,
    4. et al
    . Low blood concentration of hydroxychloroquine in patients with refractory cutaneous lupus erythematosus. Arch Dermatol 2012; 148(4):479–484. doi:10.1001/archdermatol.2011.2558
    OpenUrlCrossRefPubMed
  25. ↵
    1. Chasset F,
    2. Arnaud L,
    3. Costedoat-Chalumeau N,
    4. Zahr N,
    5. Bessis D,
    6. Francès C
    . The effect of increasing the dose of hydroxychloroquine in patients with refractory cutaneous lupus erythematosus: an open-label prospective pilot study. J Am Acad Dermatol 2016; 74(4):693–699.e3. doi:10.1016/j.jaad.2015.09.064
    OpenUrlCrossRefPubMed
  26. ↵
    1. Melles RB,
    2. Marmor MF
    . The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA Ophthalmol 2014; 132(12):1453–1460. doi:10.1001/jamaophthalmol.2014.3459
    OpenUrlCrossRefPubMed
  27. ↵
    1. Committee on Rheumatologic Care
    . American College of Rheumatology position statement. Screening for hydroxychloroquine retinopathy. www.rheumatology.org/Portals/0/Files/Screening-for-Hydroxychloroquine-Retinopathy-Position-Statement.pdf. Accessed April 2, 2018.
  28. ↵
    1. Marmor MF,
    2. Kellner U,
    3. Lai TY,
    4. Melles RB,
    5. Mieler WF,
    6. American Academy of Ophthalmology
    . Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision). Ophthalmology 2016; 123(6):1386–1394. doi:10.1016/j.ophtha.2016.01.058
    OpenUrlCrossRefPubMed
  29. ↵
    1. Mackenzie AH
    . Antimalarial drugs for rheumatoid arthritis. Am J Med 1983; 75(6A):48–58. pmid:6362406
    OpenUrlPubMed
  30. ↵
    1. Mackenzie AH
    . Dose refinements in long-term therapy of rheumatoid arthritis with antimalarials. Am J Med 1983; 75(1A):40–45. pmid:6869410
    OpenUrlPubMed
  31. ↵
    1. Melles RB,
    2. Marmor MF
    . Pericentral retinopathy and racial differences in hydroxychloroquine toxicity. Ophthalmology 2015; 122(1):110–116. doi:10.1016/j.ophtha.2014.07.018
    OpenUrlCrossRef
  32. ↵
    1. Uslu H,
    2. Gurler B,
    3. Yildirim A,
    4. et al
    . Effect of hydroxychloroquine on the retinal layers: a quantitative evaluation with spectral-domain optical coherence tomography. J Ophthalmol 2016; 2016:8643174. doi:10.1155/2016/8643174
    OpenUrlCrossRef
  33. ↵
    1. Au A,
    2. Parikh V,
    3. Modi YS,
    4. Ehlers JP,
    5. Schachat AP,
    6. Singh RP
    . Hydroxychloroquine screening practice patterns within a large multispecialty ophthalmic practice. Am J Ophthalmol 2015; 160(3):561–568.e2. doi:10.1016/j.ajo.2015.06.009
    OpenUrlCrossRef
  34. ↵
    1. Jallouli M,
    2. Frances C,
    3. Plette JC,
    4. et al
    5. Plaquenil Lupus Systemic Study Group
    . Hydroxychloroquine-induced pigmentation in patients with systemic lupus erythematosus. JAMA Dermatol 2013; 149(8):935–940. doi:10.1001/jamadermatol.2013.709
    OpenUrlCrossRefPubMed
  35. ↵
    1. Avina-Zubieta JA,
    2. Johnson ES,
    3. Suarez-Almazor ME,
    4. Russell AS
    . Incidence of myopathy in patients treated with antimalarials: a report of three cases and review of the literature. Br J Rheumatol 1995; 34(2):166–170. pmid:7704464
    OpenUrlCrossRefPubMed
  36. ↵
    1. Yogasundaram H,
    2. Putko BN,
    3. Tien J,
    4. et al
    . Hydroxychloroquine-induced cardiomyopathy: case report, pathophysiology, diagnosis, and treatment. Can J Cardiol 2014; 30:1706–1715. doi:10.1016/j.cjca.2014.08.016
    OpenUrlCrossRefPubMed
  37. ↵
    1. Pearson KC,
    2. Morrell DS,
    3. Runge SR,
    4. Jolly P
    . Prolonged pustular eruption from hydroxychloroquine: an unusual case of acute generalized exanthematous pustulosis. Cutis 2016; 97(3):212–216. pmid:27023083
    OpenUrlPubMed
  38. ↵
    1. Youngster I,
    2. Arcavi L,
    3. Schechmaster R,
    4. et al
    . Medications and glucose-6-phosphate dehydrogenase deficiency: an evidence-based review. Drug Saf 2010; 33(9):713–726. doi:10.2165/11536520-000000000-00000
    OpenUrlCrossRefPubMed
  39. ↵
    1. Ostensen M,
    2. Khamashta M,
    3. Lockshin M,
    4. et al
    . Anti-inflammatory and immunosuppressive drugs and reproduction. Arthritis Res Ther 2006; 8(3):209. doi:10.1186/ar1957
    OpenUrlCrossRefPubMed
  40. ↵
    1. Leroux M,
    2. Desveaux C,
    3. Parcevaux M,
    4. et al
    . Impact of hydroxychloroquine on preterm delivery and intrauterine growth restriction in pregnant women with systemic lupus erythematosus: a descriptive cohort study. Lupus 2015; 24(13):1384–1391. doi:10.1177/0961203315591027
    OpenUrlCrossRefPubMed
  41. ↵
    1. Clowse MEB,
    2. Magder L,
    3. Witter F,
    4. Petri M
    . Hydroxychloroquine in lupus pregnancy. Arthritis Rheum 2006; 54(11):3640–3647. doi:10.1002/art.22159
    OpenUrlCrossRefPubMed
  42. ↵
    1. Levy RA,
    2. Vilela VS,
    3. Cataldo MJ,
    4. et al
    . Hydroxychloroquine in lupus pregnancy: double-blind and placebo-controlled study. Lupus 2001; 10(6):401–404. doi:10.1191/096120301678646137
    OpenUrlCrossRefPubMed
  43. ↵
    1. James JA,
    2. Kim-Howard XR,
    3. Bruner BF,
    4. et al
    . Hydroxychloroquine sulfate treatment is associated with later onset of systemic lupus erythematosus. Lupus 2007; 16(6):401–409. doi:10.1177/0961203307078579
    OpenUrlCrossRefPubMed
  44. ↵
    1. Akpovwa H
    . Chloroquine could be used for the treatment of filoviral infections and other viral infections that emerge or emerged from viruses requiring an acidic pH for infectivity. Cell Biochem Funct 2016; 34(4):191–196. doi:10.1002/cbf.3182
    OpenUrlCrossRefPubMed
  45. ↵
    1. Pascolo S
    . Time to use a dose of chloroquine as an adjuvant to anti-cancer chemotherapies. Eur J Pharmacol 2016; 771:139–144. doi:10.1016/j.ejphar.2015.12.017
    OpenUrlCrossRefPubMed
  46. ↵
    1. Furlong HC,
    2. Wessels JM,
    3. Guerra MT,
    4. Stämpfli MR,
    5. Foster WG
    . Hydroxychloroquine attenuates cigarette smoke induced autophagic signaling in the mouse ovary. Reprod Toxicol 2016; 61:105–113. doi:10.1016/j.reprotox.2016.03.044
    OpenUrlCrossRef
  47. ↵
    1. Cairoli E,
    2. Danese N,
    3. Teliz M,
    4. et al
    . Cumulative dose of hydroxychloroquine is associated with a decrease of resting heart rate in patients with systemic lupus erythematosus: a pilot study. Lupus 2015; 24(11):1204–1209. doi:10.1177/0961203315580870
    OpenUrlCrossRefPubMed

This article requires you to have a ccjm.org account to view the full text. If you already have an account, you may log in below to view this article along with all other CCJM content. If you do not have an account, register here. It’s free!

Log in using your username and password

Forgot your user name or password?
PreviousNext
Back to top

Registration is Now Required for Free Access to CCJM Content

Register once and log in for full access to articles and content. Click “Register” in the upper right corner and follow the simple instructions to create a new account.

If you are using a mobile device, click on the settings icon to access the Register link.

In this issue

Cleveland Clinic Journal of Medicine: 85 (6)
Cleveland Clinic Journal of Medicine
Vol. 85, Issue 6
1 Jun 2018
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Cleveland Clinic Journal of Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Hydroxychloroquine: An old drug with new relevance
(Your Name) has sent you a message from Cleveland Clinic Journal of Medicine
(Your Name) thought you would like to see the Cleveland Clinic Journal of Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
3 + 6 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Hydroxychloroquine: An old drug with new relevance
Eugen Alexander Shippey, Vanya D. Wagler, Angelique N. Collamer
Cleveland Clinic Journal of Medicine Jun 2018, 85 (6) 459-467; DOI: 10.3949/ccjm.85a.17034

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Hydroxychloroquine: An old drug with new relevance
Eugen Alexander Shippey, Vanya D. Wagler, Angelique N. Collamer
Cleveland Clinic Journal of Medicine Jun 2018, 85 (6) 459-467; DOI: 10.3949/ccjm.85a.17034
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Linkedin Share Button

Jump to section

  • Article
    • ABSTRACT
    • WHAT IS HYDROXYCHLOROQUINE?
    • HISTORICAL BACKGROUND
    • HOW HYDROXYCHLOROQUINE WORKS
    • HOW WELL DOES IT WORK?
    • PHARMACOLOGIC PROPERTIES
    • HOW SAFE IS HYDROXYCHLOROQUINE?
    • PREGNANCY
    • AREAS OF UNCERTAINTY
    • CASE CONCLUSION
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Chronic hydroxychloroquine exposure and the risk of Alzheimers disease
  • Google Scholar

More in this TOC Section

  • The role of SGLT-2 inhibitors in managing type 2 diabetes
  • Prescribing testosterone and DHEA: The role of androgens in women
  • CGRP antagonists for decreasing migraine frequency: New options, long overdue
Show more Current Drug Therapy

Similar Articles

Subjects

  • Rheumatology
  • Women's Health
  • Drug Therapy
  • Allergy/Immunology

Navigate

  • Current Issue
  • Past Issues
  • Supplements
  • Article Type
  • Specialty
  • CME/MOC Articles
  • CME/MOC Calendar
  • Media Kit
  • Advertise Contact

Authors & Reviewers

  • Manuscript Submission
  • Authors & Reviewers
  • Subscriptions
  • Advertisers
  • About CCJM
  • Contact Us
  • Cleveland Clinic Center for Continuing Education
  • Consult QD

Share your suggestions!

Copyright © 2021 The Cleveland Clinic Foundation. All rights reserved. The information provided is for educational purposes only. Use of this website is subject to the website terms of use and privacy policy. 

Powered by HighWire